Provider Demographics
NPI:1508548744
Name:MARIAN SUSAN SANBORN LCSW PLLC
Entity Type:Organization
Organization Name:MARIAN SUSAN SANBORN LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SABORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-994-6920
Mailing Address - Street 1:700 AVENUE M
Mailing Address - Street 2:
Mailing Address - City:MATAMORAS
Mailing Address - State:PA
Mailing Address - Zip Code:18336-1811
Mailing Address - Country:US
Mailing Address - Phone:845-328-0133
Mailing Address - Fax:
Practice Address - Street 1:136 JERSEY AVE
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-2611
Practice Address - Country:US
Practice Address - Phone:845-328-0133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)